Wrong People – Wrong Time

The ever wonderful Mental Health Cop wrote a thought provoking blog yesterday on the subject of welfare checks (safe and well checks.)

To the uninitiated this is the broad title given to calls to the police asking them to… check the welfare of an individual. Sometimes these calls come from the public in response to someone they are unable to contact but a lot – an awful lot – are generated by other agencies.

Typical examples would be “this person has failed to attend an appointment” for some health / welfare related matter or “this person hasn’t been seen for X amount of time.”

Whether the person initiating the call has actually tried to physically attend and contact the person they are concerned about is a matter of conjecture. Quite often they have not.

Nevertheless, there will always be occasions when it is right, necessary and appropriate for the police to attend and check on someone – forcing entry in cases of genuine and real concern.

But how about this –

How about a case where mental health services have been engaging all day by telephone with an individual. That person isn’t being particularly communinicative and is saying they don’t want help. It eventually reaches the point where the person says they don’t want help and then says they intend to kill themselves first thing the following morning.

What might be the appropriate response to a call like that?

Hold whatever you’re thinking because the answer – all too frequently – is escalate it to the police.

Let’s look at the circumstances again. Someone has been in contact with mental health services all day – a known client – and there have been numerous phone calls. None of these have gone particularly well and the person gets so annoyed that they eventually say “I’ve had enough. I don’t want your help. I’m going to kill myself tomorrow.”

In these circumstances – what are we expecting the police to do? More to the point – what *can* the police actually do?
In this particular case, Mental Health services were insistent that it was the responsibility of the police to attend and check on the person’s welfare. As far as they were concerned the person was refusing to engage with them and so there was no point in them attending.

When asked why a welfare check was necessary the answer was “to make sure they haven’t killed themselves.”

“And why can’t you do that?”

“Because it’s the job of the police – it’s never been a problem before – we ask you to do it all the time.”

“But the police have no powers to deal with a mental health crisis in private. If the person answers the door or refuses to engage with us what should we do?”

“Let us know”

“And what will you do?”

“Update our notes”

“And that’s it? Update your notes?”

“Well, they won’t engage with us.”

“So you want the police to go around and speak to this person – confirm they are alive so you can update your notes? You do not plan to attend yourselves or take any further action at all in relation to their mental health?”

And so it went on……

Michael’s blog covers everything that needs to be said about the subject of welfare checks.

There is the murky issue of whether the police are actually qualified to determine anything just by looking at someone and confirming they are alive and breathing.
There is the capacity issue – why are the police being asked to do this so very often? Is it simply the case that other agencies do not have the means to carry out such visits themselves? Have the police been utilised because they are perceived to have more resources and mobile capability? Why then are some forces now seeking to enlist the Fire Service in taking on some of these calls? Are they the right people either?

There is the legal issue of whether the police can do anything about a situation when they find someone in their home in mental health crisis. The answer is no – so why are they being sent – or sent alone

Then there is the issue of stigma and trauma.

This for me is too often overlooked.
Let’s face it – when the police knock on your door it’s going to be bad news. We don’t deliver parcels and presents or winning postcode lottery cheques. We deliver terrible news, we arrest people, we usually arrive when things have gone very wrong.

Our role has historically been centred on dealing with crime and disorder. We wear a uniform and we carry defensive weapons and wear body armour. We have highly visible vehicles which almost always attract curtain twitching.

So – when you’re in crisis – do you really want uniformed police officers turning up on your doorstep?

There is much talk of parity of esteem between mental and physical health but – contrary to the best intentions of many – the police seem to be being drawn into mental health matters more and more. Not less and less as was promised.

Notwithstanding the presence of triage teams across the country the use of Section 136 of the Mental Health Act is up by 37% in five years. We were told that these schemes would free up police time and lead to a reduction.

But here’s the thing – has anyone asked the people most affected by this what kind of service they want?

Schemes such as triage, indeed police involvement in general, are things over which the service users have had no say at all. They have just been introduced and all of the professionals working within them claim they are working.

Has anyone actually asked if people really want the police rocking up when they are in crisis or if someone calls to report concerns about them? At present – they don’t have much choice. It just happens.

What is noticeable in all of the official evaluations of these schemes is the absence of service user voice. Loads of comments from staff – very few from those needing the help. And in some cases the service users responses were filtered by the professionals.

As Michael rightly points out – police involvement can make matters worse. Infinitely worse. And if not the first time then on subsequent occasions.
The experience can be so bad for some people that their instinct is to run and hide when they know the police are involved.

So – when it comes to crisis management – it’s all very well the professionals sitting around a table deciding what service to provide but the question isn’t

“What service shall we provide?”

It should be

“What service do people need and want?”

There is only one group of people who can answer this question – and it isn’t the professionals.

We are too heavily focused on the “managing the crisis” end of business and that is where the response seems to be concentrated. Talk of overuse of Section 136 and police cells misses the obvious question of “why have things got this far in the first place?”

This then leads to the wrong people being sent at the wrong time. The police will always have a role in people’s welfare but we have to ask whether they are really the best people to be answering calls such as these. Legally powerless and medically unqualified as they are. It’s a bit like calling the RAC when you find a gas leak.

If we want the police to have less to do with mental health matters then we really need to be looking more deeply at the events which build up to crises rather than constantly throwing resources at the crises themselves.

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